Failure to Monitor Medication Parameters and Complete Orders
Penalty
Summary
The facility failed to ensure that two residents received medications according to physician-ordered parameters and complete medication orders. For one resident with multiple diagnoses including dementia, psychosis, hypertension, and chronic obstructive pulmonary disease, the physician ordered metoprolol with specific parameters to hold the medication if the systolic blood pressure was below 110 or the pulse was below 60. However, review of the Medication Administration Record (MAR) for April and May showed that blood pressure and pulse were not obtained or recorded prior to administration of metoprolol on all documented occasions. Staff interviews confirmed that these vital signs should have been checked and documented before giving the medication, and that the medication should be held if readings were out of range. Additionally, the same resident had a physician's order for diclofenac gel to be applied topically to both knees, but the order did not specify the dosage amount to be applied. Staff acknowledged that the order was incomplete and should have included the dosage. Facility policies required proper monitoring, accurate documentation, and adherence to prescriber orders, but these were not followed in the cases identified, resulting in the administration of medications without appropriate monitoring or complete orders.